Mechanical ventilation and neurocritical patients: is there a role for anti-neuroinflammatory therapies?
Crit Care. 2020 01 22;24(1):22
Authors: Giordano G, Pugliese F, Bilotta F
PMID: 31969192 [PubMed - indexed for MEDLINE]
[Update and Comment on the German S3 "Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations"].
Pneumologie. 2020 Jan;74(1):46-49
Authors: Karagiannidis C, Bein T, Windisch W
In 2017 the German Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations were released. This article highlights emerging data and new concepts which were introduced since 2017. Among others it summarizes the current progress made in evidence-based recommendations of mechanical ventilation and extracorporeal membrane oxygenation (ECMO). In detail, the new evidence for treating severe ARDS with ECMO, phenotyping of ARDS, early neuromuscular blockade and the application of non-invasive ventilation and high-flow oxygen therapy are discussed.
PMID: 31958870 [PubMed - indexed for MEDLINE]
[Diagnostics of acute and chronic cough in primary care].
Internist (Berl). 2020 Jan;61(1):5-12
Authors: Rüttermann V
Cough is one of the most frequent causes for consultation in primary care. The diagnostic characteristics in primary care with a broad spectrum of causes and unspecific symptoms are presented using the example of acute and chronic cough. The understanding of the formation of the cough stimulus and the induction by inflammatory, mechanical and chemical triggers as well as the significance of the stimulus threshold of the cough receptor facilitate the comprehension of the various possible causes of cough. The necessary diagnostic procedures are based on the exclusion of warning symptoms that necessitate emergency inpatient treatment, on the duration of symptoms and the spectrum of causes to be expected from them. Ambiguities often remain even with careful basic diagnostics. Watchful waiting and active surveillance can initially be the most sensible approach but should not be misconstrued as carelessness. It necessitates follow-up controls and increased attention especially in patients with a high-risk constellation (e.g. multimorbidity, immune suppression, heart failure) in order to be able to quickly react to the development of treatable aspects or even dangerous courses of disease.
PMID: 31912164 [PubMed - indexed for MEDLINE]
Points & Pearls: Emergency department management of non-ST-segment elevation myocardial infarction
Emerg Med Pract. 2020 01 01;22(1):e1-e2
Authors: Nusbaum J, Gupta N
PMID: 31909925 [PubMed - indexed for MEDLINE]
Impact of loop diuretics on critically ill patients with a positive fluid balance.
Anaesthesia. 2020 01;75 Suppl 1:e134-e142
Authors: Libório AB, Barbosa ML, Sá VB, Leite TT
The impact of the use of loop diuretics to prevent cumulative fluid balance in non-oliguric patients is uncertain. This is a retrospective study to estimate the association of time-averaging loop diuretic exposure in a large population of non-cardiac, critically ill patients with a positive fluid balance (> 5% of body weight). The exposure was loop diuretic and the main outcomes were 28-day mortality, severe acute kidney injury and successful mechanical ventilation weaning. Time-fixed and daily time-varying variables were evaluated with a marginal structural Cox model, adjusting bias for time-varying exposure and the presence of time-dependent confounders. A total of 14,896 patients were included. Patients receiving loop diuretics had better survival (unadjusted hazard ratio 0.56, 95%CI 0.39-0.81 and baseline variables adjusted hazard ratio 0.53, 95%CI 0.45-0.62); after full adjusting, loop diuretics had no association with 28-day mortality (full adjusted hazard ratio 1.07, 95%CI 0.74-1.54) or with reducing severe acute kidney injury occurrence during intensive care unit stay - hazard ratio 1.05 (95%CI 0.78-1.42). However, we identified an association with prolonged mechanical ventilation (hazard ratio 1.59, 95%CI 1.35-1.89). The main results were consistent in the sub-group analysis for sepsis, oliguria and the study period (2002-2007 vs. 2008-2012). Also, equivalent doses of up to 80 mg per day of furosemide had no significant association with mortality. After adjusting for time-varying variables, the time average of loop diuretic exposure in non-cardiac, critically ill patients has no association with overall mortality or severe acute kidney injury; however, prolonged mechanical ventilation is a concern.
PMID: 31903562 [PubMed - indexed for MEDLINE]
Trials on oxygen supplementation in sepsis: better late than never.
Intensive Care Med. 2020 01;46(1):116-118
Authors: Perner A, De Jong A, Shankar-Hari M
PMID: 31773178 [PubMed - indexed for MEDLINE]
Training adult laypeople in basic life support. A systematic review.
Rev Esp Cardiol (Engl Ed). 2020 Jan;73(1):53-68
Authors: González-Salvado V, Rodríguez-Ruiz E, Abelairas-Gómez C, Ruano-Raviña A, Peña-Gil C, González-Juanatey JR, Rodríguez-Núñez A
INTRODUCTION AND OBJECTIVES: Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness.
METHODS: We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale.
RESULTS: Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects.
CONCLUSIONS: While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.
PMID: 30808611 [PubMed - indexed for MEDLINE]